HomeMy WebLinkAboutRenzulli OFFICE OF THE TOWN CLERK Icl\FFOLifi;
Town of Southold
Judith T. Terry, Town Clerk .
Town Hall, 53095 Main Road . ••
P. O. Box 1179 ;:1•81
Southold, New York 11971 �O` - 0•c-
Telephone =�1 t '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 212 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool X
NAME OF OWNER: Achilles Renzulli
OWNER MAILING ADDRESS: 1070 Westwood Lane, P.O. Box 724
Greenport, New York 11944
OWNER PROPERTY ADDRESS:1070 Westwood Lane
Greenport, New York
OWNER TELEPHONE NUMBER:516-477-1178
TAX MAP NO. : Section 33 Block 2 Lot 18
CROSS STREET: Inlet Pond Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: February 3, 1987
(TOWN SEAL)
ii I' /
OFFICE OF THE TOWN CLERK \FFO
Town of Southold ��� * - eQl', Application No. a''
Judith T. Terry, Town Clerk .` r ii ,
Town Hall, 53095 Main Road ��,� Residential
P. O. Box 1179 u' k '' *i ; Non-Residential
Southold, New York 11971 O
f
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. aW--
Fee $ � D
DATE /-3o-
OWNER
-3o-OWNER NAME: Oft/� -e� /1/2 L/
OWNER MAILING ADDRESS: /j772 it/Es��ivo w aG'� x 7 /
RzEiv ®,e Al,X 0391
OWNER PROPERTY ADDRESS: 5 /9 gOec
OWNER TELEPHONE NUMBER: Y77" //7,
TAX MAP NO. : Section 31 Block Lot /8
CROSS STREET: UZ-FT 73,i/7 Rho
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential !/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: NO
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature .Applican
RECEIVED BY:gt- -.c,-
RELIC Vetlown krk's Of ce
DATE: FEB 0 3 1987
Town Clerk Southold
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